08. ABC 7-Eleven
City Hall
10300 Torre Avenue
Cupertino, CA 95014
(408) 777-3212
Fax; (408) 777-3366
OFFICE OF THE CITY MANAGER
SUMMARY
AGENDA ITEM NUMBER Y
SUBJECT AND ISSUE
AGENDA DATE tJDY~k'fSI;;LlJtJ7
Application for Alcoholic Beverage License.
BACKGROUND
1.
Name of Business:
Location:
Type of Business:
Type of License:
Reason for Application:
RECOMMENDATION
7-Eleven Store
21490 McClellan Road
Convenience Store
Off Sale Beer & Wine (20)
Person-to-Person Transfer and Annual Fee
There are no use permit restrictions or zoning restrictions which would prohibit this use and staff has
no objectionto the issuance of the license.
Prepared by:
~LJ<. Z-oL) c;2d!...QJL-P
Ciddy WordZl, City Planner
Submitted by:
Qu
David W. Knapp, City Manager
Prlnt9d on Recycled Paper
8 - 1
Department of Alcoholic Beverage Control
APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE{S)
ABC 211 (6/99)
State of California
TO: Department of Alcoholic Beverage
100 Paseo de San Antonio
Rm. 119
San Jose, CA 95113
(408 )277 -1200
DISTRICf SERVING LOCATION:
Control
File Number: 460471
Receipt Number: 1636759
Geographical Code: 4303
Copies Mailed Date: October 11, 2007
Issued Date:
First Owner:
Name of Business:
SAN .lOSE
7 ELEVEN INC
7-ELEVEN STORE 2367-25717C
Location of Business:
21490 MCCLELLAN RD
CUPERTINO, CA 95014-4052
SANTA CLARA
County:
Is premise inside city limits?
Mailing Address:
(If different from
premises address)
Yes
Census Tract 5077.01
PO BOX 2245
BREA, CA 92822-2245
Type of licensees): 20
Transferor's license/name:
333952 /7 ELEVEN INC
Dropping Partner:
Yes_
NoL
License Type Transaction . Type Fee Type Master J:2Ju1 ~ m
20 OFF-SALE BEER ANI PERSON TO PERSON TRANSF NA Y 0 10/11/07 $50.00
20 OFF-SALE BEER ANI ANNUAL FEE NA Y 0 10/11/07 $220.00
30 TEMPORARY PERMl' DUPliCATE NA Y 1 10/11/07 $100.00
20 OFF-SALE BEER ANI FEDERAL FlNGERPRINTS NA N 1 10/11/07 $24.00
Total $394.00
Have you ever been convicted of a felony? No
Have you ever violated any provisions of the Alcoholic Beverage Control AC4 or regulations of the
Department pertaining to the Act? No
Explain any "Y cs. answer to the above queations on an attachment which aball be deemed part of this application.
Applicant agrees (a) that any manager employed in an on-sale licensed premise will have all the
qualifications of a licensee, and (b) that he will not violate or cause or permit to be violated any of the
provisions of the Alcoholic Beverage Control Act.
STATE OF CALIFORNIA County of SAN!' A CLARA Date: October 11, 2007
Under penalty of perjury, each person whose signature appears below, certifiea and says; (1) He Is an applicant, or. one of the applicants, or an
executive officer of the applicant corporation. named In 'the foregoing application. duly authoHzed to make this appiication on its behalf; (2) thlll
he has read the foregoing and knows the contenta thereof and thlll each of the above statements therein made are true; (3) . thaI no person other
Ihan the applicanl or applicants hili any direct or indirect interest in the applicant or applicant's business 10 be conducted under the Iicense(a) for
which this application is made; (4) thai the transfer application or proposed transfer is not made to satisfy the paymenl of a Joan or to fulfi1l an
agreemenl entered into more than ninety (90) days preceding the day on which the transfer application is flied with the Department or to gRin or
cstablish II preference to Qr for any creditor or transferor or to defraud or injure any creditor of transferor; (5) that the transfer application may
be withdrawn by either the applicanl or the licensee wilh no resulting Iiablllty to the DepartmenL .
Applicant Name(s)
7 ELEVEN INC
NGUYEN WNG pm
Applicant Signature(s)
~~~ 211 ~ignatllr~ Pag~
" " " "
8-2
Department of Alcoholic Beverage Control
State of California
APPLICATION SIGNATURE SHEET ("SIGN ON")
. This form is to be used as the signature page for
applications not signed in the District Office.
. Read Instructions on reverse before completing.
. All sIgnatures must be notarized In accordance with
laws of the State where signed.
2. ALE NUMBt'R (If any) 3. LICENSE TYPE
20
1. OWNERSHIP TYPE (Check one)
o Sole Owner
Kl Partnership
o Husband & Wife
o Partnership-Ltd
4. TRANSACTION TYPE
o Corporation
o Limited Liability Company
o Other
o Original
o Exchange
~ Person to Person Transfer
o Premise to Premise Transfer
o Other
5. APPLlCANT(S) NAME (Las~ r~st, middle)
7-Eleven, Inc. and Nguyen, Long Phi
6. APPLICANTS MAILING ~ESS (811891 addresslP.O. box, elly. slale, zip code)
P.O. Box 2245, Brea CA 92822-2245
7. PREMISES ADDRESS (SInMll address, city, zip coda)
2~490 McClellan Road, Cupertino CA 95014-4052
APPLICANT'S CERTlF/CA TlON
Under penalty of perjury, each person whose signature appears
below, certifies and says: (1) He/She is an applicant, or one of
the applicants, or an executive officer ofthe applicant
corporation, named in the foregoing aPElication, duo ly authorized
to make this application on its behlilf; (2) that he/she has read
the foregoing and knows the contents thereof and that each of the
above statements therein made are true; (3) that no person other
than the applicant or applicants has any direct or indirect interest
in the applicant or applicant's business to be conducted under the
licell8e(s) for which this application is made; (4) that the transfer
application or proposed transfer is not made to (a) satisfy the
SOLE OWNER
payment of a loan or to fulfill an agreement entered into more than
ninety (90) days preceding the day on which the transfer
application is filed with the Department, (b) to ~ain or establish a
preference to or for any creditor or transferor, or (c) to defraud or
mjure any creditor or transferor; (5) that the transfer application
may be withdrawn by either the applicant or the licensee with no
resulting liability to the Department.
I understand that if! fail to qualify for the license or withdraw this
application there will be a servIce charge of one-fourth of the
license fee paid, up to $100.
8_ PRINTED NAME (last. firs\, middle)
I SIGNATURE
X .
PARTNERSHIP/LIMITED PARTNERSHIP (Signatures
I DATE SIGNED
general partners only)
DATE SIGNED
9. PARTNER'S PRINTED NAME (Las\, firs\' middle)
Nguyen, Long Phi
PARTNER'S PRINTED NAME (LasI. firs\, middle)
X
SIGNA
X
PARTNER'S PRINTED NAME (Last, firsI. middle)
SIGNATURE
P-12 Oakland
CORPORATION 7-Eleven, Inc.
10. PRINTED NAME (Last, lIrat, middle)
Huey, David George
TITLE
X
DATE SIGNED
o President 0 Vice President
PRINTED NAME (LasI. first, middle)
Varela, Antonio Enrique
TITLE
D Secretary 0 Asst. Secretary D Chief Financial Officer D Asst. Treasurer
LIMITED LIABILITY COMPANY
11. The limited liability company Is member-run
DYes DNo
(If no, complete Item #12 below)
ABC INITIALS/DATE (ABC use only)
12. NAME OF DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFACER (Las\, firsl. middle)
13. MEMBER'S PRINTED NAME (Last, firsl, middle)
SIGNATURE
DATE SIGNED
X
MEMBER'S PRINTED NAME (LasI. ftrsl. middle)
SIGNATURE
DATE SIGNED
ABC-211-SIG(2103)
X
"SIGN ON"
8-3
SIGNATURE ACKNOWLEDGEMENT FOR ABC DOCUMENTS
ABC-211-SIG ("SIGN-ON")
~T/STOEU&# .7-Eleven Store 2367-25717C
ADD~ 21490 McClellan Road
Cupertino CA 95014-4052
APPLICANT (8):.
7-Eleven, Inc.
and
Long Phi Nguyen
and
State of California
County of Alameda
On this the .Q \ ~-l-
d~yof '1.,~~~'
. ~eo) , before me,
Susan Curry Flores, Notary Public
, the undersigned personally appeared,
Antonio Enrique Varela
~-A -CK{
Signature
Typed Name
~
personally known to me to be the person who executed this
document and all other necessary ABC forms submitted in
connection with this application as Assistant Secretary for
7-Eleven, Inc. and acknowledged to me that the corporation
executed them.
Seal
.
8-4
SIGNATURE ACKNOWLEDGEMENT FOR ABC DOCUMENTS
ABC.ZU-SIG ("SIGN-ON")
MARKET/STORE # 7-Eleven Store 2367-25717C
AJ)DRE88 21490 McClellan Road
Cupertino CA 95014-4052
APPLICANT (8):
7-Eleven, Ine.
and
Long Phi Nguyen
and
State of California
County of Alameda
Onthisthe~dayof ~~f'L~.
Susan Curry Flores
Q~ "') , before me,
, Notary Public, the undersigned personally appeared,
David George Huey
,L.~-....yy ~7
Signature
Typed Name
I2l
personally known to me to be the person who executed this
document and all other necessary ABC forms submitted in
connection with this application. .
IA A A & AA'A~~~_~OR;;.I
...@.........COMM.'1535801,
is Notary Publlc:-Callfomla
W .' . ALAMeDA COUfflY
I~? y T?~? ~~,,~.~~7~~T I
Seal
8-5
SIGNATURE ACKNOWLEDGEMENT FOR ABC DOCUMENTS
ABC-211.SIG ("SIGN-ON")
MARKET/STORE #
7-Eleven Store 2367-25717C
ADDRESS
21490 McClellan Road
Cupertino CA 95014-4052
APPLICANT (8):
7-Eleven, Inc.
and
Long Phi Nguyen
and
State of California
County of Alameda
On tbis the Q I ~~
day of Sl~~ hD-^.
, ~eo" , before me,
Susan Curry Flores
, Notary Public,
the undersigned personally appeared,
~
" Signature
--
.....
Long Pbi Nguyen
Typed Name
o
personally known to me to be the person who executed ABC document
211-SIG, and all other necessary ABC forms submitted in connection with
this application.
.J
J~~'~~~~.~~~~~~~I
.... COMM.'1~1
ii . Notal')' P.ubttc-Caft:lml8 I!!
W' ALAJIEDACOUN1'Y ~
J~ T T ~ _ T T ~~T~~~~~TI
Seal
8-6